Laparoscopic versus Open Distal Pancreatectomy for Pancreatic Neuroendocrine Tumors

Abstract

Introduction: Pancreatic neuroendocrine tumors (pNETs) are increasingly detected incidentally. Distal pancreatectomy for left-sided pNETs is commonly performed laparoscopically. This review compares short-term and oncologic outcomes of laparoscopic versus open distal pancreatectomy for pNETs.

Methods: A literature search was performed in PubMed and Scopus for comparative studies of laparoscopic versus open distal pancreatectomy for pNETs. Outcomes were R0 resection, lymph node harvest, overall survival, and postoperative pancreatic fistula.

Results: Eleven studies (three propensity-matched) were included. Laparoscopic distal pancreatectomy was associated with shorter hospital stay, less blood loss, and comparable pancreatic fistula rates. R0 resection rates were equivalent. Lymph node harvest was similar or slightly lower in the laparoscopic group, but this did not translate into survival differences. Disease-specific survival was excellent in both groups (over ninety percent at five years).

Discussion: Most pNETs are non-functional and small, making them ideal for minimally invasive resection. The spleen can be preserved in selected patients, though the impact on oncologic outcomes is negligible for low-grade tumors. Larger tumors and those with suspected malignancy may still benefit from open surgery to ensure complete lymphadenectomy.

Conclusions: Laparoscopic distal pancreatectomy for pNETs is safe and provides equivalent oncologic outcomes to open surgery, with faster recovery. It should be considered the standard approach for left-sided pNETs in appropriate candidates.